SBUMC Celebrates Year One of Ground Breaking National Quality Improvement Effort to Reduce Waiting Time in the ED

Stony Brook is one of six hospitals in the US participating in RWJ Foundation Funded Program

STONY BROOK, NY, December 17, 2009 – As hospitals across the United States strive to operate efficient and effective emergency departments (EDs) in the face of today’s increasingly strained health care environment, Stony Brook University Medical Center (SBUMC) celebrated its early successes in Urgent Matters, a ground breaking effort to reduce ED overcrowding, which involves just six hand-selected hospitals across the country, including SBUMC.

Funded by the Robert Wood Johnson Foundation and managed by a national program office at the Center for Health Care Quality at The George Washington University Medical Center School of Public Health and Health Service, Urgent Matters Learning Network II is an 18-month national initiative dedicated to finding, developing and measuring the effectiveness of strategies to improve patient flow and reduce ED crowding.

“Emergency Department visits are up 7.7% this fiscal year; our admissions are up 9.8%; we are in the expansion mode right now, but expansion is not the solution,” said Eric Niegelberg, Administrative Director of the Emergency Department at Stony Brook. “Stony Brook is working on getting our patients seen and treated quickly by enhancing our diagnostic processes and relying on new technology – such as the Electronic Medical Record – to create efficiencies in the communication process.”

As part of its implementation process, Stony Brook formed a multidisciplinary team with representatives from the Continuous Quality Improvement Department (CQI), Emergency Department, Management Engineering, IT and administration.

Stony Brook identified three areas of focus for the Urgent Matters initiative:

- Electronic ED Consults – Electronically tracking and following up with emergency department physician consults can reduce patient waiting time. Typically there is no method for tracking the number of daily ED consults or how long the consult process was taking. The Urgent Matters team developed an electronic tracking process using Cerner, the Hospital’s healthcare information technology system, which provides a tracking log, paging system, and response time. The medical specialist completes the consult by clicking on the order to indicate that the patient consult is complete; feedback is then provided to the specialist service about the consult turnaround times to raise awareness and foster continuous improvement in turn around times.

- Abdominal Pain Protocol – By staffing the ED triage area with a Nurse Practitioner, waiting time can be significantly cut when patients presenting in the ED with abdominal pain have their labs ordered prior to being seen by the ED physician.

- CTA Protocol – CT angiography/coronary imaging to rule out cardiac disease has succeeded in drastically reducing waiting time and patient admissions. According to Eric Niegelberg, Administrative Director of the Emergency Department, 93 percent of the 60-70 patients who present every month with chest pain are now discharged because the CTA is an efficient diagnostic tool for ruling out cardiac disease.

Through Urgent Matters, Stony Brook is also participating in the development of national standards for performance measurement in Emergency Departments. The hospital submits monthly data about length of stay for admitted versus discharged patients, decision to admit times and time to pain management for long bone fracture patients. This data will be used to establish benchmarking times for emergency departments nationwide.

"Emergency departments provide a critical health care safety net for all Americans and in every community. They are the one place that is always open, the place where everyone knows they can always turn to get the care that they need," said Bruce Siegel, MD, MPH, director of the Center for Health Care Quality at the George Washington University Medical Center School of Public Health and Health Services, which is managing Urgent Matters. "The work of this initiative is helping hospitals across the country tackle the vexing issues of ED crowding and ensure patients receive the best care."

Recent studies have deemed America’s hospital EDs to be at a breaking point, weighed down by overcrowding as patient volumes have steadily increased, while at the same time, capacity has decreased. According to the U.S. Centers for Disease Control, from 1996–2006, the number of annual ED visits grew from 90.3 million to 119.2 million nationally. Meanwhile, the number of hospitals operating EDs in the United States declined from more than 5,000 in 1991 to fewer than 4,000 in 2006. The result was that the number of ED visits rose 32 percent, while the number of hospital EDs across the country dropped almost 5 percent – leaving an increasing number of patients concentrated in a smaller number of EDs.

“ED overcrowding is a well-known and critical issue that, in the context of healthcare reform, hospitals need to understand and address in order to provide the best possible emergency care for their communities,” said Steven L. Strongwater, M.D., CEO of Stony Brook University Hospital. “Dr. Viccellio, recognized throughout the Emergency Medicine industry for creativity and problem solving ‘hallway protocol initiative,’ has led Stony Brook in it’s pivotal role in trying to mitigate ED overcrowding by relocating patients from the hallway to the unit. The groundbreaking work we are undertaking now is going to help hospitals throughout Long Island and the country to do even more. We are advancing the field of emergency care for everyone.”

Overcrowding is a problem faced by any hospital operating an ED, with the potential for serious negative consequences for health care access, quality and patient safety to result. Patients entering an overcrowded ED face longer wait times for care, meaning that some leave the ED without being seen. It also disrupts ambulance service in the region. Research has also shown that increases in ED overcrowding are associated with increased waiting times for painkillers and antibiotics, greater mortality and more adverse health care events.

“It is a real honor, to be selected by Urgent Matters, whose theme it has been to get the best ideas from participating institutions and share them with a wider audience, including hospitals,” said Dr. Peter Viccellio, Vice Chairman of Emergency Medicine at Stony Brook University Medical Center. “I can’t thank the staff enough for their dedication and teamwork in moving this forward, and to Christine McMullen, Director of Continuous Quality Improvement, for keeping us all on track.”

The six hospitals participating in Urgent Matters will collaborate through a ‘learning network’ structure to test new ideas, quantify results and share lessons learned. Program successes will be shared nationwide, giving other hospitals and stakeholders concrete and tested examples of effective promising practices and interventions that they can adopt in their own EDs.

Hospitals now participating in Urgent Matters are following in the groundbreaking footsteps of the first Urgent Matters Learning Network, which provided breakthrough research on patient flow measurement and improvement. Launched in 2002, 10 hospitals in the original collaborative implemented rigorous performance measures, assessed existing processes and used techniques of rapid cycle change to improve ED throughput and output.

The current Urgent Matters Learning Network is building upon those earlier successes to advance the development of quality improvement performance metrics in EDs by field-testing and evaluating industry and CMS-endorsed ED performance measures for the first time. Working in collaboration with the U.S. Agency for Healthcare Research and Quality (AHRQ) and the Health Research & Educational Trust (HRET), an affiliate of the American Hospital Association, participating hospitals will track and submit data to HRET on two CMS measures in order to evaluate the impact and effectiveness of those improvement strategies.

For more information on Urgent Matters, including a copy of the final report from the program’s first Learning Network, “Bursting at the Seams,” visit www.UrgentMatters.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in our lifetime.

Stony Brook University Medical Center is the only academic medical center on Long Island. It comprises Stony Brook University School of Medicine and Stony Brook University Hospital, which is the only tertiary care hospital and Level 1 trauma center in Suffolk County. With 571 beds and more than 5,100 employees, it is the largest hospital in Suffolk County. The Heart Center performs the only open-heart surgery in Suffolk and the Cancer Center and Cerebrovascular Center attract patients from throughout the region with cutting edge diagnostic and treatment facilities. Stony Brook is home to Long Island’s first kidney transplantation program which has performed over 1,100 transplants, and initiated the nation’s first Pediatric Multiple Sclerosis Center. The hospital is also the regional referral center for trauma, perinatal and neonatal intensive care, burns, bone marrow and stem cell transplantation, cystic fibrosis, pediatric/adult AIDS, and is the regional resource center for emergency management. Stony Brook’s Stroke program is certified by the Joint Commission and the NYS Department of Health; and, Stony Brook is home to the Cody Center for Autism and Developmental Disabilities and Long Island’s first comprehensive ALS Center.